Percutaneous coronary intervention (PCI) performed in patients having myocardial infarctions is the most effective reperfusion strategy. Getting the patient to the catheterization lab (door-to-balloon time) in the quickest manner has proven to decrease mortality. The ability to obtain timely PCI, however, may be limited by delays in delivery. Several strategies have quantified minutes saved per strategy associated with significant reduction in mortality. Costs of each of these strategies are unknown. Due to the significantly different costs and different effectiveness of each these strategies, a cost-effective analysis needs to be done. The over all goal of this project is to improve the health of patients presenting with myocardial infarctions and ultimately, to apply technology assessment methods to the field of acute cardiac care to provide evidence for the most cost-effective allocation of resources. The goal will be accomplished by addressing the following specific aims: (1) estimate costs of strategies shown to reduce door-to-balloon times for patients with ST-elevated Ml (STEMIs); and (2) compare the incremental cost-effectiveness of strategies shown to be effective in reducing door-to-balloon times in patients with STEMIs. To determine the inputs/resources necessary to implement and maintain the strategies that will be used in the cost-effective analysis, hospital leaders whose door-to-balloon times are less than 90 minutes will be interviewed and then 150 hospitals will be surveyed to gain the knowledge of the estimated costs and resources needed to implement each of the strategies. Secondly, a cost-effectiveness model will be developed to evaluate the different strategies that reduce door to balloon time. Cost will be inputted into the model. Time-saved, which equates to a decrease in mortality, will also be inputted into the model as the outcomes associated with each of the strategies. With the costs of each strategy determined and a model built based on the literature, incremental cost-effectiveness of each strategy shown to reduce door-to-balloon time will be evaluated. Several sensitivity analyses will be conducted to test the robustness of the results to changes in the assumptions and estimates used in the model. Findings may suggest changes in funding patient care pathways and changes in allocation of resources to more cost-effectively reduce door-to-balloon times and therefore mortality. Additionally, this information is likely to influence policy makers and payer decisions, as it will give a more complete picture of which strategies are the most cost-effective. This will have an important positive impact by placing a value on each strategy and may help determine if the improved outcomes are worth the potential increased cost associated with the specific strategy. [unreadable] [unreadable] [unreadable]